for Social Workers

Health Care Social Workers Meet to Discuss Superstorm Sandy

At the end of October 2012 Tropical Storm Sandy evolved into Hurricane Sandy, wreaking havoc throughout the Caribbean while working its way up the coast through the Mid-Atlantic States and then devastating the Northeast. Subsequently, downgraded from Hurricane force, but certainly maintaining superstorm status, Sandy became one of the costliest Atlantic hurricanes, second only to Katrina, creating close to $66 billion in damage and responsible for an estimated 253 deaths.

Sandy profoundly affected New York’s health care social workers. The storm surge and ensuing flooding was responsible for the unprecedented closing of four major medical centers: Bellevue Hospital Center, NYU Langone Medical Center, the Manhattan campus of the Veterans Administration New York Harbor Health System and Coney Island Hospital, as well as the closing of many skilled nursing facilities, assisted living facilities and adult homes throughout the area. Thousands of patients were displaced and thousands of health care workers redeployed (including hundreds of social workers).

On December 4th at the Hospital for Special Surgery, the New York City Chapter of NASW in conjunction with the New York Metropolitan Chapter of the Society for Social Work Leadership in Health Care (SSWLHC) cosponsored, “Health Care Social Workers Respond to Superstorm Sandy, Lessons Learned, A Call to Action”. A panel of health care social work leaders was convened and moderated by the SSWLHC President Carol Dejesus, LCSW to discuss how the storm impacted their respective facilities, how social workers were deployed during the storm preparation/duration and immediate aftermath and to review post-storm staff deployment.

The panel included Robin Blumenthal, LCSW, Assistant Director of Social Work and Home Care at Beth Israel Medical Center; Susan Conceicao, LCSW, Director of Psychosocial Services for Metropolitan Jewish Health Services; Tom Sedgwick, LCSW, CCM, Director of Social Work at NYU Langone Medical Center (NYULMC); Ines Suarez, LCSW, Director of Social Work at Bellevue Hospital Center; and Phyllis Erlbaum-Zur, Ph.D., LCSW, Director of Metropolitan Jewish Health System – Kittay House Hospice (representing Menorah Center for Rehabilitation).

The panel members discussed the contributions of their social work staff in response to the storm:

Mr. Sedgwick spoke of social workers at NYULMC coordinating approximately 200 patient discharges from the medical center prior to the October 29th storm and evacuation of the remaining 325 patients from NYULMC in the midst of the storm.

• Mr. Sedgwick spoke of social workers at NYULMC coordinating approximately 200 patient discharges from the medical center prior to the October 29th storm and evacuation of the remaining 325 patients from NYULMC in the midst of the storm.
• Ms. Suarez discussed how the Bellevue staff evacuated patients in the aftermath of the storm with limited power, no elevators and inadequate means of communication.

• Ms. Conceicao recounted the challenges home care workers had responding to hundreds of isolated patients without power, water, food and medications.

• Ms. Erlbaum-Zur spoke of the difficulties Menorah nursing home had evacuating elderly disabled patients and the role of social work in contacting and supporting families.

• Ms. Blumenthal spoke of the increase in Beth Israel’s census and the dearth of available beds as the hospital most impacted by the closing of nearby Bellevue, NYULMC, and the VA.

• Both Mr. Sedgwick and Ms. Suarez spoke about the redeployment of social work staff to other hospitals to assist with the extraordinary demands created by the temporary closing of four major hospitals – Bellevue staff has been redeployed at other Health and Hospital Corporation sites while NYULMC staff has been redeployed to Lenox Hill, St. Luke’s/Roosevelt, Beth Israel, and Hospital for Joint Disease.

• The NYULMC social workers were also involved in visiting and/or calling relocated NYULMC patients to ensure that these patients had the opportunity to process their feelings about the evacuation and to assist in a coordinated transition of care.

A Call to Action

Ms. Dejesus called “to action” the audience of about 50 health care social workers. The group identified communication challenges during Sandy and discussed ways that the SSWLHC and NASW might collaborate in the future to facilitate better communication and support of one another during a major crisis. Madelyn Miller, LCSW, chair of NASW’s Disaster Trauma Committee was present to remind the group to be conscious of supporting self-care among health care social workers responding to the needs of patients and families impacted by Sandy, while perhaps also having been directly affected by the storm. Health care social workers personally affected by Sandy, either directly or through vicarious exposure, are at risk for experiencing “shared trauma” as they help their patients most harmed by Sandy. Through self-care and a chance to process the event, these workers also have the opportunity to experience post-traumatic growth. Bob Schachter, Executive Director of NASW was also present and invited the group to become more involved with NASW’s Disaster Trauma Committee.

The group spoke about exploring whether there are opportunities for social work to be more involved with the New York City Department of Health Emergency Preparedness Coordinators group and with the City’s Office of Emergency Management where the Greater New York Hospital Association and Health and Hospitals Corporation have representation. The group ended the evening by agreeing to form a subcommittee to further explore how the SSWLHC can respond to future disasters.

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What We Are Learning for the Future

In the Wake of Superstorm Sandy

Almost three months after the devastation of Superstorm Sandy first reached the city, following a path of destruction across the Caribbean, suffering continues throughout our region. We are still absorbing the magnitude and the implications of this unprecedented reality: the tragic loss of life, homes, and communities; our city brought to a standstill; and many people are still without having their most basic needs met. The significant social dimensions of this natural disaster astound us. And while it may seem otherwise, we are situated at an early point in the long-evolving aftermath of this disaster. Individuals, families, and communities, and also social workers, will be engaged over months and years, and perhaps intergenerationally, in expressing their experiences of loss, trauma, and disruption, and their steps forward, with uniquely determined timetables.
As social workers the impact has touched us personally and professionally, and at the same time, we are also involved in remarkably diverse professional and community roles. Our vulnerabilities and our resilience coexist. We lost homes, office use, places of work, and our programs. We lost connections to clients, staff, and colleagues. Some social workers evacuated patients in the midst of the storm. Some social workers are still located in other work settings, negotiating the variety of challenges. Some worked with an intersection of social work students, clients, staff, and settings each directly affected by the storm. Some social work students, faculty, and staff lost their school. And social workers volunteered. Some social workers engaged in disaster work through the American Red Cross, the Medical Reserve Corps, and other disaster-specific organizations, working on hotlines, at shelters, and food distribution sites. Some social workers participated with grassroots, community-based groups, houses of worship, and local organizations, searching for residents - and providing support and reassurance. Other social workers initiated opportunities to provide collegial support, discussions, and training.

For so many, having opportunities to help, to find meaningful ways to respond, to experience agency, and to express commitments to social action and social justice, seemed essential. At the same time such work in the midst of such devastation and profound need is demanding, emotionally exhausting, and often without immediate support. It is essential that we create opportunities among colleagues to discuss our experiences, its challenges, its enrichment and engagements, and its inevitable impact. We need to support one another, create restorative collective experiences, a sense of communality, and encourage reflective self-care. And there is a wealth of learning that is possible from our colleagues who have lived through related experiences, for instance, those on the Gulf Coast since Hurricane Katrina and Rita, those in Japan since the recent tsunami, and those working after the Indian Ocean tsunami.

In the midst of challenges to provide support for those most affected and to move forward as a community, a month ago we learned of the tragedy in Newtown. Its parameters of intentionality, loss of life, and loss of children, framed by the realities of gun violence and gun access, mental health issues, and a culture of violence and violation, remain deeply affecting. And they include broader contexts, highlighting the complex social dimension of this human-caused disaster, which extends beyond the profound sorrow in relation to one community, to many neighborhoods and more children. In fact, we may reference Dunblane, Scotland, Columbine, New York City, Virginia Tech, Los Angeles, Breslan, Chechnya, Chicago.

What have we learned?

Social workers quickly identified those uniquely vulnerable in this disaster, including homebound and semi-homebound older adults, in particular if not previously known to any services; individuals with disabilities; long-term homeless individuals without access to their subway, underground, and above ground areas; and those who may be more generally vulnerable after any mass disaster, including those who have lived through previous disaster, trauma, loss, disruption; those who are refugees; those seeking asylum; those undocumented; those struggling to maintain a carefully crafted stability in their lives. Obvious and glaring gaps in service were identified, in spite of some excellent related programs: affordable housing, mental health systems, nursing home care, homeless services. And health concerns about mold were unfolding.

Across the city, the outpouring of volunteers toward community-based and grassroots initiatives has been remarkable; it has changed the landscape of disaster response, and will need to be taken into account as future planning gets underway. This expression of collective, community response to help neighbors who are the most vulnerable, has included people who have been previously marginalized by poverty and racism, those in public housing, or those whose homes or areas were devastated.

Additionally, we observed that well-established community centers and neighborhood groups, those highly trusted among local residents, became sustaining hubs of support; they provided food, services, and information, and became places for community, belonging, social engagement, activism, and community building. As we know, after the collective experience of disaster, collective efforts and responses are particularly sustaining. The stabilizing impact of active, engaged community life after disaster, through institutions of trust, and reestablishing elements of daily life, the cultural foundations of a community, for children, adolescents, adults, and older adults cannot be overemphasized. We can incorporate into our efforts the support of community continuity. We can also support long-term opportunities for community members to engage in helping neighbors.

As time unfolds our work ahead will include those just now and later beginning to take in the dimensions of these experiences. We can anticipate expressions of individual and collective loss, mourning, and memorializing, as well as attention to anniversaries. With continuing care we can support such individual and collective experience as it may evolve into broader conversations and considerations of meaning and hope.

We need to create ongoing support for our experiences of vicarious trauma, vicarious transformation, and vicarious resilience, along with the direct and shared trauma and loss of our work. Through collegial support, and restorative collective experiences, reflective self-care, social engagement, social action, social justice efforts, continuing learning, and meaningful commitments, we can take care of ourselves.

In preparation for diverse future response efforts, we can connect with American Red Cross, the Medical Reserve Corps, CERT (Community Emergency Response Teams), and other disaster organizations, and can receive specialized disaster training. Such training includes Psychological First Aid, and can consider guidelines for ethical international psychosocial capacity building work.

At a recent meeting of health care specialists, one social worker shared moving observations of displaced nursing home residents becoming joyful to see their original social workers who had come to visit them at their temporary facilities. Once back to their original nursing homes, the residents felt greatly comforted and relieved, happy to finally return to their residential settings, even though in more modest housing. This powerfully underlines the sustaining experiences of our empathic engagements, professional relationships and connections, and the fundamental importance of a sense of home, place, and community, for client and social worker alike, and for all those across our city and beyond.

Please join the next meetings of the Disaster Trauma Committee, January 18, February 15, and March 15, 9 to 11 a.m., at the Chapter office, 50 Broadway, Suite 1001. Any train to the Wall Street area is within walking distance. These meetings consider the diversity of emerging issues related to Superstorm Sandy, the Newtown shooting, and other intersecting disasters within a global context. Support and attention is given to our own inevitable experiences of working in the midst of and after disaster. To inquire about the Disaster Trauma Committee, please email the Chapter office at contactus@naswnyc.org.

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REST Assured!

Resilience and Emotional Support Team (REST) Provides Mental Health Response

Adela M. Rodriguez, LMSW, Field Response Coordinator, New York City Department of Health and Mental Hygiene Office of Mental Health Disaster Preparedness and Response

Mrs. Rodriguez provides the on-site administration and oversight of those response activities in the aftermath of disasters in New York City. Mrs. Rodriguez began her career in Disaster Management as the Assistant Director for Family Support Services with the National American Red Cross - September 11th Recovery Program (SRP). Her disaster management experience also includes volunteer recruitment and training of spontaneous volunteers being deployed to New Orleans following Hurricane Katrina. Mrs. Rodriguez has also held various positions at local New York City Settlement Houses and community based organizations, including: Assistant Director of Senior Services, Homeless Shelter Housing Specialist, Social Worker and mental health practitioner. Mrs. Rodriguez received her Master’s in Social Work from Fordham University - School of Social Work. She trains mental health responders in Psychological First Aid and All Hazards Disaster Mental Health and holds certificates in Brief treatment interventions and Skills for Psychological Recovery. She has lived, worked and studied abroad in both Europe and Asia.

The role of the Bureau of Mental Health (BMH) at the New York City Department of Health and Mental Hygiene (DOHMH) is to coordinate the response to the mental health needs of New Yorker’s following disasters and other public health emergencies. Coordination at this level requires a great deal of planning and preparation as well as a strong cadre of mental health professionals who understand the psychological impact of disasters, are knowledgeable about evidence-based disaster mental health interventions and are ready for deployment with short notice. To that end, BMH has organized a mental health response group known as the Resilience & Emotional Support Team (REST Team).

REST was formed out of a unique collaborative partnership with the Medical Reserve Corp (MRC) and is comprised of qualified, trained individuals, from social workers to psychologists and psychiatrists, who, when activated, can be rapidly mobilized to provide onsite disaster mental health support by providing information and referral, Psychological First Aid (PFA), psycho-educational material and crisis counseling.

At this time DOHMH is seeking to increase the number of trained disaster mental health volunteers available to respond as members of our REST team. There are currently over 350 trained REST responders. REST responders provide emotional support in the community and/or at City-designated response sites and have played an important role in some of the City’s responses, including the H1N1 influenza pandemic, the construction crane collapse, the casino highway bus crash, Hurricane Irene, and most recently Superstorm Sandy.

Superstorm Sandy had a major psychological impact on New Yorkers and in order to meet the needs of those impacted, REST responders were utilized to provide mental health support at the City’s special medical needs shelters - 24 hours per day for 3 weeks. REST responders were instrumental in supporting shelter operations by providing emotional support and helping individuals navigate the shelter system. As shelters are often a chaotic environment, sometimes without support, individuals can become overwhelmed. In Queens, a DOHMH staff MH responder prevented this from happening by taking the time to connect with a hard to reach gentleman who was about to be sent from the shelter to a nursing home. By talking and taking the time to listen to his story she learned that he in fact owned a house he wanted to return to. This MH responder went the extra mile and escorted the senior to his home to assess the damage. Upon returning to the shelter she helped him lay out a plan so he could return to his home permanently.

Another example of a REST responder helping an evacuee feel more at ease was in a shelter in Brooklyn. At this shelter, the REST responder assisted an evacuee who came to the shelter alone and spoke limited English to connect with a group from her community who spoke her language. This helped reduce her anxiety and increase her social support system to enhance her ability to cope better with her situation, including the possibility of losing her home. These are just two examples of REST responders providing the much needed support in the field throughout the shelters.

Lessons learned from Superstorm Sandy have reinforced the need to expand recruitment efforts and seek collaborations with professional organizations such as the National Association of Social Workers (NASW). To that end, we are partnering with New York City’s NASW’s Disaster Trauma Committee to provide training to interested Social Workers looking to participate in NYC’s responses system as REST responders.

All REST responders must complete a mandatory free full day training entitled “All Hazards Disaster Mental Health” (which includes PFA), and attend related trainings throughout the year on various disaster related topics. Individuals who join the REST team will gain satisfaction from knowing that they are collectively helping New Yorkers respond to and recover from the mental health implications of disasters and public health emergencies.